Bazille, Mary Maureen

Bazille, Mary Maureen is an individual health care provider with primary practice located at 2450 Riverside Ave , Minneapolis MN 55454-1450. She recently has only one registered license in Dietary & Nutritional Service Providers / Nutritionist, which is considered as her primary health care specialty. Bazille, Mary Maureen can be contacted via phone (612) 273-4395.

Contact Information

Primary practice address
2450 Riverside Ave Minneapolis MN 55454-1450
Phone: (612) 273-4395
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Nutritionist 133N00000X 994556 Virginia

Profile Details

NPI number 1700042702
LBN Legal business name Bazille, Mary Maureen
Credentials Registered Dietitian (RD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 30th, 2008
Last updated Dec 28th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700042702 NPPES
Virginia MEDICAID 004909976

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